Shadowy Visual Disturbances: Causes and Treatments

Visual floaters?

Hello, doctor.
In the past, when I slowly moved my eyes to the far left, far right, and far up, I would notice a progressively larger, blurred circular shadow in my field of vision that seemed like a thin veil (it was just a thin layer, and I could still see, but it felt like it was covered by a black veil).
Sometimes it wasn't a shadow, just a transparent distortion.
Both eyes experienced this, but it was not in the center of my vision; rather, it appeared on the new sides of my peripheral vision.
When I turned my eyes back to the front, the shadow would shrink and disappear.
Recently, the symptoms seem to have increased.
Whenever I fixate straight ahead and move my head side to side towards my shoulders, I also notice a thin, veil-like shadow in the lower part of my vision, close to my nose, resembling a quarter-circle shadow extending from the nasal side.
Similarly, when I return my head to the neutral position, it shrinks and disappears.
I feel like I am not straining my eyes too much; just tilting my head causes this to appear, which makes me quite anxious.
I have symptoms of floaters (occasional flashes of light in my vision) and elevated intraocular pressure (currently being treated with eye drops to control the pressure).
My family has a history of macular degeneration.
May I ask: 1.
What disease could be causing these symptoms? 2.
Are there any treatment options available? Thank you.

Jiao Lü de Z, 20~29 year old female. Ask Date: 2022/09/26

Dr. He Jianxian reply Ophthalmology

It still sounds like the symptoms of floaters.
It is recommended to consult an ophthalmologist for a dilated fundus examination.
If the fundus is normal, there should be no need for excessive concern.
Director He Jian-xian, Department of Ophthalmology, Nantou Hospital.

Reply Date: 2022/09/26

More Info

The visual disturbances you are experiencing, characterized by shadowy or translucent shapes appearing in your peripheral vision, could be attributed to several potential causes, particularly given your history of floaters (known as "myodesopsia") and elevated intraocular pressure.
1. Possible Causes:
- Vitreous Degeneration: Given your age and the presence of floaters, it is likely that you are experiencing vitreous degeneration. This occurs when the gel-like substance in the eye (the vitreous humor) begins to liquefy and pull away from the retina, leading to the perception of shadows or distortions in your vision. The shadows you describe, which appear to grow larger with eye movement, could be due to the interaction of the vitreous with the retina or the way light is refracted through the vitreous gel.

- Retinal Issues: The symptoms you describe, especially the presence of shadows that change with head movement, could also indicate potential retinal issues, such as retinal tears or detachment. These conditions can lead to serious vision problems and require immediate medical attention.

- Visual Field Defects: The appearance of shadows or distortions in your peripheral vision could also be related to visual field defects, which can occur due to various ocular conditions, including glaucoma, especially since you mentioned having elevated eye pressure.

2. Diagnosis and Treatment:
- Comprehensive Eye Examination: It is crucial that you undergo a thorough eye examination by an ophthalmologist. This should include a dilated fundus examination to assess the health of your retina and vitreous. Optical coherence tomography (OCT) may also be used to visualize the layers of the retina and detect any abnormalities.

- Monitoring and Management: If your symptoms are determined to be due to vitreous degeneration, there may not be a need for treatment unless there are signs of retinal tears or detachment. In such cases, treatment options may include laser therapy or surgical intervention to repair the retina.

- Managing Eye Pressure: Since you are already on medication to control your intraocular pressure, it is essential to continue monitoring this condition. Elevated eye pressure can lead to glaucoma, which can cause peripheral vision loss if left untreated. Regular follow-ups with your eye care provider are necessary to ensure that your eye pressure remains within a safe range.

3. Lifestyle Considerations:
- Eye Health: Maintaining a healthy lifestyle can support overall eye health. This includes a balanced diet rich in antioxidants (like leafy greens and fish), regular exercise, and avoiding smoking. Additionally, protecting your eyes from UV exposure with sunglasses can help prevent further degeneration.

- Visual Hygiene: If you spend long hours in front of screens, ensure you take regular breaks to reduce eye strain. The 20-20-20 rule is a good practice: every 20 minutes, look at something 20 feet away for at least 20 seconds.

In summary, while your symptoms may be related to vitreous changes, it is imperative to rule out any serious conditions such as retinal tears or glaucoma. Prompt evaluation by an eye care professional is essential to determine the underlying cause of your symptoms and to establish an appropriate management plan. Your anxiety is understandable, but taking proactive steps towards diagnosis and treatment can help alleviate your concerns and protect your vision.

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